Evidence Synthesis for Decision Making 4: Inconsistency in Networks of Evidence Based on Randomized Controlled Trials

Sofia Dias*, Nicky J Welton, Alex J. Sutton, Deborah M Caldwell, Guobing Lu, A E Ades

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)

305 Citations (Scopus)
340 Downloads (Pure)

Abstract

Inconsistency can be thought of as a conflict between "direct" evidence on a comparison between treatments B and C and "indirect" evidence gained from AC and AB trials. Like heterogeneity, inconsistency is caused by effect modifiers and specifically by an imbalance in the distribution of effect modifiers in the direct and indirect evidence. Defining inconsistency as a property of loops of evidence, the relation between inconsistency and heterogeneity and the difficulties created by multiarm trials are described. We set out an approach to assessing consistency in 3-treatment triangular networks and in larger circuit structures, its extension to certain special structures in which independent tests for inconsistencies can be created, and describe methods suitable for more complex networks. Sample WinBUGS code is given in an appendix. Steps that can be taken to minimize the risk of drawing incorrect conclusions from indirect comparisons and network meta-analysis are the same steps that will minimize heterogeneity in pairwise meta-analysis. Empirical indicators that can provide reassurance and the question of how to respond to inconsistency are also discussed.

Original languageEnglish
Pages (from-to)641-656
Number of pages16
JournalMedical Decision Making
Volume33
Issue number5
DOIs
Publication statusPublished - Jul 2013

Keywords

  • network meta-analysis
  • inconsistency
  • indirect evidence
  • Bayesian
  • immunodeficiency virus prevalence
  • treatment comparison meta-analysis
  • mixed treatment comparisons
  • competing interventions
  • surveillance data
  • validity
  • bias

Projects

Activities

  • 3 Participation in workshop, seminar, course
  • 1 Invited talk

INSERM Workshop 234: Network meta-analysis

Sofia Dias (Invited speaker)

4 Jun 2015

Activity: Participating in or organising an event typesParticipation in workshop, seminar, course

HEOR Indirect: Comparaciones indirectas entre fármacos. Metodología y aplicación.

Sofia Dias (Speaker)

3 Nov 2015

Activity: Participating in or organising an event typesInvited talk

35th Annual Meeting of the Society for Medical Decision Making

Sofia Dias (Speaker)

20 Oct 2013

Activity: Participating in or organising an event typesParticipation in workshop, seminar, course

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